An extraordinary sight often greets visitors to the canteen of St Peter's primary school in East Bridgford, Nottinghamshire. Seated alongside the Þve- to 11-year-olds, a group of pensioners can be found tucking into their own school dinners. Instead of the usual meals-on-wheels fare, the guests can enjoy the school's award-winning lunches and, by doing so, taking part in a pioneering healthy-eating programme.
Other schools will shortly join the scheme, which has become the model for a series of measures aimed at reducing diet-related illnesses. Behind the approach is the belief that the key to reducing the incidence of accidents and illness - and thus reducing the strain on the NHS - is forging a meaningful and practical partnership with the community.
Evidence of its success can be seen in the results of a pilot study that appears to have led to a dramatic reduction in the number of falls suffered by older people. It is a little-known fact that over-65s are more likely to die from a fall than from cancer or heart disease. Treating falls costs the NHS as much as £1.7bn a year.
The pilot study suggests that the adoption of simple measures - such as providing older people with night lights or getting them to throw away "sloppy" slippers - can play a huge part in preventing falls. In one area, falls were cut by almost 80%. On that kind of basis, or anything like it, the potential of savings is enormous.
The study, known as the healthy communities collaborative, is an initiative by the Department of Health's national primary care development team (NPDT), using evidence gathered by the Health Development Agency (HDA).
The Þndings are now being put into practice nationally and, buoyed by the success, the agency and the development team are hoping to use the same kind of community partnership to tackle the rising tide of obesity - a major health problem that is linked to heart disease, type 2 diabetes, high blood pressure and osteoarthritis.
The National Audit OfÞce is projecting that by 2010 one in four adults will be obese. The total cost to the NHS and the economy will be some £3.6bn a year. Figures from the Food Standards Agency show that more than 24 million adults are classiÞed as obese. In the past 10 years, obesity among six-year-olds has doubled to 8.5% and among 15-year-olds it has trebled to a devastating 15%.
Over the past 20 years, obesity levels have trebled in the general population - and these levels are continuing to rise. "Obesity is a massive problem," says Linda Henry of the NPDT. "In 1998, about 30,000 deaths were attributable to obesity. It reduces life expectancy by, on average, up to nine years."
Project managers are encouraging people to think of imaginative ways to promote healthy eating and to make fruit and vegetables more readily available. For some, this means adopting the example of St Peter's, whose school canteen is open to pensioners every Wednesday and Friday during the school term. Parents are also welcome to drop in.
Jeanette Orry is the enterprising school dinner lady who opened the doors to the community and replaced junk food with organic and locally produced meat and vegetables. She has already started advising projects set up at the three pilot sites used for the falls project: Easington in County Durham, Gateshead and Northampton.
Each of these has pockets of deprived areas, where low-income groups have difÞculty gaining access to a healthy diet. This may because they cannot afford the price of fresh fruit and vegetables, or because they do not have the transport to travel to shops where it is sold.
Bringing down these barriers forms a key plank of the nutrition project, which relies on a partnership approach. Teams of health professionals and local authority and voluntary workers are helping members of the community tackle the problem.
As well as getting schools to produce healthier school dinners and open up canteens to older people, the teams want corner shops to stock fresh produce and set up food cooperatives and delivery schemes. Programmes are being established to encourage people to experiment with different ways of cooking and different types of food, and there will also be grow-your-own schemes. Older people from the falls project will act as mentors and recruit others.
"We have already talked about the importance of diet when we spoke to the over-65s about osteoporosis and falls," says Henry. "They will end up going into schools themselves and will pass on messages about healthy eating to their grandchildren and families."
This kind of communication is vital. Researchers believe that messages about healthy living can be counter-productive if people feel they are being preached to. "That is the last thing we want," says Dame Yve Buckland, who chairs the HDA. "Our job is to provide the evidence, then people take it and pepper it with their own energy and creativity."
In the falls project, schemes were tailored to meet the needs of local communities. Armed with a grant of £75,000 for each pilot site, teams were asked to come up with ideas. Although the teams included a cross-section of professionals, the majority of members were local residents. This led to a variety of schemes ranging from tai chi, which improves balance, to the improvement of local footpaths and the installation of hand rails. Checks were carried out on older people on medication in case they were suffering any side-effects that made them more liable to fall.
Sue Watts, from the Northampton primary care trust healthy communities collaborative - where initiatives include free line dancing - says the real work is done by the older people themselves. "The depth of the involvement of the community makes this different from other projects. Older people themselves were organising events and, at times, were coming up with ideas that were challenging health professionals' way of thinking," Watts says.
It did not take long for people to join in falls-prevention events organised in the three areas. As awareness grew, there was a corresponding drop in the number of accidents involving older people. In the last month of the study, ambulance service Þgures revealed the number of falls had reduced by 60%, and by up to 79% in Northampton. According to the NPDT, if the results were replicated nationwide, the NHS would save £386m a year, and there would be a further, knock-on saving of £326m in residential care.
The Þndings have amazed specialists in the Þeld. "These results are absolutely staggering and have huge implications for social services and the health service," says Rose Anne Kenny, head of geriatric medicine at the Royal Victoria InÞrmary, Newcastle upon Tyne. "The savings would be in the millions."
However, Kenny, who chairs the American and British Geriatric Society's falls-prevention group, believes the Þgures need to be treated with caution. "There has to be a randomised trial with a control group to see if this really works, or is some fluke," she says.
Like the falls projects, the success of the nutrition initiatives will be measured after 12 months. Researchers will see if schools have reduced the salt and fat content in school dinners and will check if the number of local outlets selling fruit and vegetables has increased. At the same time, people will be questioned on their eating habits.
Buckland says the falls study will be subject to a full evaluation. But she believes it could dramatically improve older people's health and quality of life. She is also excited at the prospect of similar improvements in other areas of public health.
"What has been achieved so far is remarkable. Now we want to see how far we can replicate this in other areas. After obesity, we might look at ways of getting more people to exercise. There is also a need to increase breastfeeding and to reduce childhood accidents," Buckland says.
Once you have engaged the community, it seems, there really is no limit.
For more on community health initiatives: www.hda-online.org.uk
For more on public health: society.theguardian.com/publichealth
